Ephedra Exposed

Pills, Politics & People

The Supplement, Used To Help Boost Energy And Lose Weight, Is One Of The Most Problematic And Puzzling.

October 23, 2000|By Linda Shrieves of The Sentinel Staff

Walk into most gyms and health-food stores, and you'll find an array of dietary supplements -- pills used by people to lose weight and sports drinks gulped by athletes to give them a boost while working out.

But what most consumers don't know is this: Ephedra, the herb that is the prime ingredient in many of those products, may carry deadly consequences.

The federal government has been scrutinizing ephedra for more than five years and says ephedra-based products have been associated with the deaths of 60 people. Since 1995, 1,173 Americans have reported reactions, such as strokes, heart attacks and psychotic episodes, while taking ephedra products.

For officials of the Food and Drug Administration, ephedra is the most compelling and problematic of herbs. Agency officials strongly suspect that ephedra may be triggering deadly reactions, but they don't have enough scientific evidence to prove that ephedra is deadly. And without conclusive scientific proof, the agency cannot stop sales of ephedra or ephedra-based products, according to a law passed by Congress in 1994.

The law, the Dietary Supplement Health and Education Act of 1994, created a new category of products called dietary supplements -- a grouping that includes herbs, vitamins, minerals, amino acids and even steroid hormones. Thus the $9.5 billion Americans spent on herbal medicines that are supposed to remedy numerous maladies also bought them exposure to misinformation, health threats and danger.

Unlike over-the-counter cold medicines or prescription medicines, these products aren't tested for safety before they go into stores. If a supplement -- whether it's an ephedra product or a synthetic amino acid -- is making people sick, the agency must prove that it's dangerous before it can ban the product.

It's a no-win situation, says Wallace Sampson, former professor at Stanford University's School of Medicine.

"We can't do that kind of study on ephedrine," he says. "You can't take someone and give them all this stuff until something happens to them. It's hard to investigate these kinds of things because you can't experiment on people that way. So you wait until you get a critical number of cases that all look the same."

However, he says that the evidence gathered so far against ephedra "looks very suspicious."

Nonsense, say spokesmen for the Ephedra Education Council, a group of ephedra manufacturers. Last year, 3 billion servings of ephedra were consumed by an estimated 9 million Americans, according to the Ephedra Information Council. The group contends that only 25 serious reactions were reported to manufacturers.

Complicating matters is ephedra's history in this country. Chinese scientists introduced ephedra -- or ma huang -- to Americans because the herb's chemicals, including ephedrine and pseudoephedrine, are helpful in treating asthma, as well as congestion from colds.

In a half dozen countries, including Canada, Germany and Great Britain, ephedra and ephedrine are available only by prescription. In the United States, it remains an over-the-counter product.

NEW USES FOR AN OLD HERB

Americans have discovered, however, another use for ephedrine and ephedra. Thousands of people are using ephedrine, usually combined with caffeine, to lose weight. Bodybuilders have begun taking ephedra pills -- usually combined with caffeine, aspirin or both -- to give them energy before working out.

And there has been one other change: In the past, Americans used ephedrine cold medications or asthma medicines for only a few days. Now, many Americans are taking ephedra daily for months or years.

Ephedrine -- one of the chemicals found in the herb ephedra -- has been marketed as "legal speed," and when herbal ephedra is combined with caffeine, it has many of the same effects: raising blood pressure and making the heart beat rapidly.

But doctors and pharmacy professors suspect that these new uses for ephedra may point to the problem. What is most striking, FDA and consumer advocates say, are the numbers of young, apparently healthy people who have had strokes and heart attacks after using ephedra products.

The industry maintains that people who suffered reactions had undiagnosed heart problems. Victims' family members, however, contend ephedra triggered irregular heartbeats or spiked blood pressure that led to cardiac arrest.

Questionable cases reported to the FDA include:

21-year-old John Lesemann, a police-academy cadet in New Jersey, took the ephedra product Hydroxycut and died while running during training. His family is suing the manufacturer.